The Effects Of Total Parathyroidectomy With Auto-transplantation On Quality Of Life In Maintenance Hemodialysis Patients With Refractory Secondary Hyperparathyroidism

Objective: This study aimed to evaluate whether the total parathyroidectomy with auto-transplantation can improve clinical symptoms and quality of life in maintenance hemodialysis(MHD)patients refractory secondary hyperparathyroidism(SHPT).Methods: Eighty patients with maintenance hemodialysis who were diagnosed as refractory SHPT and successfully underwent PTX+AT in our hospital since January 1,2017 and were followed up one year after surgery were included.The age,sex,dialysis age,primary disease,annual family income,education level and other general demographic data of the patients were recorded before surgery.Biochemical indexes such as Ca,P and i PTH were tested before and 1 year after operation.The parathyroid resection symptom assessment scale(PAS)and the renal disease and quality of life questionnaire(KDQOL-36)were used to evaluate the clinical symptoms and quality of life before and one year after surgery,and the improvement of clinical symptoms and quality of life before and after surgery was compared.Results:1、A total of 42 males and 38 females were included in this study,with an average age of(47.211±7.962)years and an average age of dialysis(7.901±2.693)years.The first three primary diseases were chronic glomerulonephritis,diabetic nephropathy and hypertensive renal damage.2、Before the operation,the serum i PTH of all the patients was greater than 800pg/ml,the blood phosphorus compliance rate was 32.5%,and the blood calcium compliance rate was 68.75%.Among them,54 cases(67.5%)were hyperphosphatemia and 25 cases(31.25%)were hypercalcemia.The incidence of postoperative hypocalcemia was 93.75%(75/80),most of which could be corrected by calcium supplementation 3 months after the operation.All patients had good postoperative wound healing without recurrent laryngeal nerve injury or wound infection.3、Follow-up at 6 months after the operation showed that the blood phosphorus compliance rate was 87.5%(70/80)and the blood calcium compliance rate was 96.25%(77/80).Three patients developed refractory hypocalcemia,requiring regular intravenous calcium supplementation.4、The 1-year follow-up,the serum i PTH compliance rate was 98.75%,the blood phosphorus compliance rate was 82.5%,and the blood calcium compliance rate was 88.75%.There were 14 cases of hyperphosphatemia(17.5%)and 6 cases of hypercalcemia(7.5%).SHPT recurrence occurred in 1 case(1.25%)and SHPT persistence in 17 cases(21.25%).No deaths occurred within 1 year after surgery.5、Compared with that before the operation,1 year after the operation,the serum levels of calcium,blood phosphorus,calcium phosphorus product and serum parathyroid hormone(i PTH)were significantly decreased(t=6.732,10.454,12.962,24.941,all P<0.05).Total PAS score(618.130±196.371 vs.336.501±91.332,t=11.791,P=0.001)decreased and total PAS score(51.760±13.671 vs.78.252±9.901,t=18.831,P<0.001)increased.Conclusion: The total parathyroidectomy with auto-transplantation can effectively improve clinical symptoms and quality of life in maintenance hemodialysis patients with refractory secondary hyperparathyroidism...